Abstract
Scabies is a contagious skin infection commonly occurring in institutions such as care homes. However, a large proportion of vulnerable people in England receive domiciliary care in the community and their experience of scabies has not been described. We undertook a pragmatic cross-sectional survey of Health Protection Teams (HPTs) in England to determine the burden of scabies related to domiciliary care. Fifteen cases or outbreaks were notified to HPTs between January 2013 and December 2017. Although a relatively uncommon event for individual HPTs, they were complex to manage and required the co-ordination of multiple stakeholders. Diagnosis was often delayed and required several clinical consultations. A lack of guidance led to difficulties establishing stakeholder roles and responsibilities and sources of funding for treatment. The stigmatisation of scabies sometimes affected the quality of care provided to patients, such as use of excessive personal protective equipment. Our study demonstrates that scabies is an issue of public health importance for domiciliary care service providers and users, and research is required to better understand the impacts of the disease and to develop evidence-based guidance. More generally, there is a need for simpler treatment regimens and methods of diagnosing scabies.
Highlights
Scabies is a highly contagious skin condition caused by burrowing Sarcoptes scabiei mites [1]
Responses were received from Health Protection Teams (HPTs) across England describing a total of 15 incidents or outbreaks related to scabies and domiciliary care
All reported incidents and outbreaks included more than one case of scabies, apart from one which concerned a single case of scabies in a care worker with no affected service users identified following clinical assessment
Summary
Scabies is a highly contagious skin condition caused by burrowing Sarcoptes scabiei mites [1]. It causes intense and prolonged itching, and excoriations can lead to secondary bacterial infections [2]. Outbreaks of scabies in care home settings have been widely documented and are often difficult to recognise and manage, especially in residents with communication difficulties or dementia [4, 5, 6]. Control of an outbreak requires co-ordinated treatment with topical creams of all cases and contacts, which can be logistically challenging, resource intensive and distressing for residents with dementia who might not understand the reason for treatment [4]. Systemic treatment with a single dose of ivermectin has been demonstrated to effectively treat scabies without the need for topical creams [7], it is unlicensed for this use in the UK and is only currently recommended in combined use with creams for severe cases that do not respond to topical treatment
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